ER nurse getting paramedic

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Hi! Do you think it is helpful for a nurse to get a paramedic or PHRN certification if they work in the ER? Does that training better prepare you for your job?

Specializes in Emergency Department.

Hi Daisy! Thanks. What are the differences between a RN to paramedic program and a normal paramedic program?

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Specializes in Trauma/ED.

I looked into my EMT-B just for fun and to play with my buddies in EMS but the amount of hours I would have to do in an ambulance was too grueling. There was an accelerated course for RN's at the time which was just a couple weeks of class time and a bunch of hours on the job. To keep the cert I would have had to do monthly drills and volunteer for a number of hours...no thanks. Getting your EMT-P is a lot more difficult and would be very hard to maintain with a full time RN job...course this is all in my area--it's different in every state.

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I looked into my EMT-B just for fun and to play with my buddies in EMS but the amount of hours I would have to do in an ambulance was too grueling. There was an accelerated course for RN's at the time which was just a couple weeks of class time and a bunch of hours on the job. To keep the cert I would have had to do monthly drills and volunteer for a number of hours...no thanks. Getting your EMT-P is a lot more difficult and would be very hard to maintain with a full time RN job...course this is all in my area--it's different in every state.

Really? Here the basics do four emergency runs and 24 hours of ER time. I remember doing double that because I enjoyed it.

Getting the paramedic and keeping it is a royal pain though. Only recently did Arkansas change from requiring a 48 hour refresher every two years to allow instead for CEUs although it's a lot of them. Even when the refresher was required, however, we still had to do CEUs on prescribed topics. You still have to have a physician medical director sign your papers every two years to renew your license though. "Licenses" are new as well. We used to have only "certifications."

I think more medic programs are going to full-time class days which I think will be their downfall. It's already hard to get and keep paramedics. There's a shortage. I've never known anyone to go to paramedic school that didn't already work somewhere else full-time. Why drop the evening programs? It's beyond me.

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Hi Daisy! Thanks. What are the differences between a RN to paramedic program and a normal paramedic program?

No such program is recognized in my state, but from those I've looked at on the internet the RN had to already be an EMT-B. That's good too. A standard paramedic program encompasses about 600 clinical hours in the ER, ICU, OR for purposes of intubation, and we had one day surgery, peds, OB (which none of us did), and a day in radiology to do. There's also a didactic (classroom) component which I think is, or was, 600 hours as well. All said, it took me from August of one year to December of the following year to finish paramedic school. We had class four hours per night for two nights per week.

The RN-medic program would probably detail cardiology and EKGs, airway management and monitoring, trauma, and the assorted procedures the paramedics do. Nurses can do them as well, but they're not within the scope of traditional nursing school. There'd also have to include some element of EMS-specific material although a lot of that would come from the basic EMT class that would be prereq. That would include assorted legal matters, scene safety, hazmat, extrication, and the different idea that in EMS the patient does not come first as it does in nursing. In EMS it's YOU then your PARTNER.

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No such program is recognized in my state, but from those I've looked at on the internet the RN had to already be an EMT-B. That's good too. A standard paramedic program encompasses about 600 clinical hours in the ER, ICU, OR for purposes of intubation, and we had one day surgery, peds, OB (which none of us did), and a day in radiology to do. There's also a didactic (classroom) component which I think is, or was, 600 hours as well. All said, it took me from August of one year to December of the following year to finish paramedic school. We had class four hours per night for two nights per week.

Why drag out something that is still listed as "hours of training" rather than credit hours or degrees into something any longer than it is? Was that just to say your program took 1.5 years rather than 6 months? Take the Paramedic cert for what it is worth which is an add on cert for FFs. There is not really such a thing as a standard paramedic program. Some programs are 600 hours (300 and 300) total like in Texas. The clinical hours are also deceiving when you can spend hours and hours playing on the internet, watching TV or sleeping for at least 8 hours without any patient contact but still rack up the hours to meet the requirement. But, maybe that is what makes the Paramedic program very attractive to some.

There is also very little clinical oversight for the paramedics in the hospitals. Some show up get their paper signed by someone and then show up again 8 hours later expecting someone to initial all the skills they say they did but no one saw. Many hospitals also no longer allow ETI by Paramedic students in either the OR or ED. They definitely are no longer allowed in some L&Ds or NICUs after a few bad incidents.

The EMT-B is basic first aid. You can actually get more hours at the ARC but a 2 - 3 week EMT course is easier and takes less time. The clinicals can be a joke but you may get to ride real fast in an ambulance and they may even let you play with the lights and sirens.

The RN-medic program would probably detail cardiology and EKGs, airway management and monitoring, trauma, and the assorted procedures the paramedics do. Nurses can do them as well, but they're not within the scope of traditional nursing school. There'd also have to include some element of EMS-specific material although a lot of that would come from the basic EMT class that would be prereq. That would include assorted legal matters, scene safety, hazmat, extrication, and the different idea that in EMS the patient does not come first as it does in nursing. In EMS it's YOU then your PARTNER.

The biggest legal matter would be still being held accountable as an RN even when you think you are only working under your Paramedic cert.

You still have to have a physician medical director sign your papers every two years to renew your license though.

I don't see where this is a big deal. The MD should be active especially in oversight of your skills and knowledge. In the hospital competencies for some skills and knowledge are tested yearly with some having a mandatory number to obtain. As I have mentioned before, a Paramedic could work on rescue for years and not do a tube or maybe make on attempt just to say "they intubated". Some are going with one experienced Paramedic in a fly car that can go from call to call and do the major "skills" and "drugs" so the others don't have to.

Do you actually get to meet your medical director or does the supervisor collect all the renewals and have the MD sign them at one time? Many EMS systems have one medical director for the entire county who just signs a bunch of forms and probably has never met any of the Paramedics.

There's a shortage. I've never known anyone to go to paramedic school that didn't already work somewhere else full-time. Why drop the evening programs? It's beyond me.

Shortage? The medic mills are putting out Paramedics in 6 months or less. There is a demand for some who want to have the Paramedic card to make them eligible to be a FF. Even those who say they are working for the patient at private companies still rush their application to the FD each time there is an announcement. The last time we had 10 FF openings we had 1000 applications and almost all had their Paramedic card even if they have never worked as one and probably don't plan to until they get hired with the FD.

If every FF in a county can pass the Paramedic, especially when they have no interest in even being a Paramedic, how hard do you think it is? FFs also have no problem balancing and maintaining their Paramedic cert along with being a FF.

If the OP wants to be a Paramedic with a real interest in patient care, take a class with RNs and hopefully the state has a PHRN or MICN credential. Being in a class where all the students only want to get a job as a FF and could care less about patient care might cause one to be disillusioned.

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Why drag out something that is still listed as "hours of training" rather than credit hours or degrees into something any longer than it is? Was that just to say your program took 1.5 years rather than 6 months? Take the Paramedic cert for what it is worth which is an add on cert for FFs. There is not really such a thing as a standard paramedic program. Some programs are 600 hours (300 and 300) total like in Texas. The clinical hours are also deceiving when you can spend hours and hours playing on the internet, watching TV or sleeping for at least 8 hours without any patient contact but still rack up the hours to meet the requirement. But, maybe that is what makes the Paramedic program very attractive to some.

There is also very little clinical oversight for the paramedics in the hospitals. Some show up get their paper signed by someone and then show up again 8 hours later expecting someone to initial all the skills they say they did but no one saw. Many hospitals also no longer allow ETI by Paramedic students in either the OR or ED. They definitely are no longer allowed in some L&Ds or NICUs after a few bad incidents.

The EMT-B is basic first aid. You can actually get more hours at the ARC but a 2 - 3 week EMT course is easier and takes less time. The clinicals can be a joke but you may get to ride real fast in an ambulance and they may even let you play with the lights and sirens.

The biggest legal matter would be still being held accountable as an RN even when you think you are only working under your Paramedic cert.

I don't see where this is a big deal. The MD should be active especially in oversight of your skills and knowledge. In the hospital competencies for some skills and knowledge are tested yearly with some having a mandatory number to obtain. As I have mentioned before, a Paramedic could work on rescue for years and not do a tube or maybe make on attempt just to say "they intubated". Some are going with one experienced Paramedic in a fly car that can go from call to call and do the major "skills" and "drugs" so the others don't have to.

Do you actually get to meet your medical director or does the supervisor collect all the renewals and have the MD sign them at one time? Many EMS systems have one medical director for the entire county who just signs a bunch of forms and probably has never met any of the Paramedics.

Shortage? The medic mills are putting out Paramedics in 6 months or less. There is a demand for some who want to have the Paramedic card to make them eligible to be a FF. Even those who say they are working for the patient at private companies still rush their application to the FD each time there is an announcement. The last time we had 10 FF openings we had 1000 applications and almost all had their Paramedic card even if they have never worked as one and probably don't plan to until they get hired with the FD.

If every FF in a county can pass the Paramedic, especially when they have no interest in even being a Paramedic, how hard do you think it is? FFs also have no problem balancing and maintaining their Paramedic cert along with being a FF.

If the OP wants to be a Paramedic with a real interest in patient care, take a class with RNs and hopefully the state has a PHRN or MICN credential. Being in a class where all the students only want to get a job as a FF and could care less about patient care might cause one to be disillusioned.

Well, let's see...so much to debate. You really seem to be one of the nurses that don't like paramedics. Ok, let's begin.

I mentioned hours of training just to mention hours of training to give the OP an idea of how much time would be spent sitting in class and how much time would be spent at the hospital. As an aside, we weren't given an amount of hours to spend on an ambulance but instead a number of runs to make so the 600 clinical hours referred to the in-hosptial setting. The program required 1200 hours total (minimum), but there's that gosh darn number again. It's hard to rotate through hospital sleeping and watching tv, but it's great to hear that's possible! I also don't recall how many credit hours the program was and personally view that as all but irrelevant.

There is little clinical oversight for EMS students in the hospital environments and for a number of reasons many of which include poor this all too familiar attitude but also largely because no one in the hospital really knows what paramedics do nor why they're there. A few bad accidents with intubations, eh? Well, way to generalize and slam a profession. I'm pretty sure they still do it around here. I personally enjoyed the daylights out of it and took to it like a fish to water, but again that's only personal experience.

Playing with the lights and siren can be fun. No need to be jealous. Just become an EMT and you can do it all you want. Yes, a basic EMT is quite limited in scope, and all EMTs and many nurses know this. Most EMTs, yes MOST EMTs, do not work in EMS nor care to. A lot of them are firefighters, police officers, search and rescue workers, and industrial and factory workers who take on the role as a collateral dute as well as individuals who merely like to be prepared for whatever may happen. The latter is what stimulated me to first take the course.

Again, it wouldn't matter with regards to the legal scope. If an RN can't work in the field, unless as in the case of an aeromedical unit which you pointed out in another thread then there would be no legal accountability. What could you as an RN do in back of an ambulance anyway that an equipped paramedic can't? You plan on buying and packing along an array of extra supplies?

Yep, mostly the papers are sent to the doctor and signed. I can't think of any place where it's different When I actively worked I met him, yes. It's not a glorified role, lol nor hard to do. He's an FP with a clinic in town. Rare is the emergency medicine physician in Arkansas.

Again, I only speak from personal experience. There is a shortage of paramedics here. People aren't interested in the field for a couple of reasons including minimal wages and rapid burnout. You can't even be a licensed paramedic here unless you're working and can verify employment. I'd love for some six month paramedic mills to hit Arkansas. We need them.

Most fire departments and agencies that utilize paramedics provide them with continuing education much as a hospital would for nurses. Getting paid to do the time while you're at work is easy. It's the people that don't work everyday as a paramedic that find difficulty. I know I did.

People like being firefighters. Steady work with good benefits and a liveable wage. Private EMS agencies hardly provide that which is who I worked with. I was a volunteer firefighter for seven years, and I can understand the appeal of doing the job. I'm not interested in it anymore, but I used to be. Granted, I never got to lounge around as firefighters do since we lived our lives and responded via pager, but who wouldn't like being paid to sit and watch tv? You also get to help people which is what you nurses like to do isn't it?

PHRN and MICN isn't recognized here.

I'm going to make a statment that many EMS providers aren't always the most clean cut, educated people. Look at the salaries of the profession. People that can do better than paramedic usually do better than a paramedic. Others enjoy it just the same and stick with it. Perhaps you're basing your opinion on a bad encounter. Either way it's your opinion. I also would not call an ambulance to come to me unless I was entrapped in something or needed spinal immobilization. That's something I learned being a paramedic due to response and scene times, but they do save people. If EMS wasn't efficacious it wouldn't exist.

Can't wait to hear from you!

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Well, let's see...so much to debate. You really seem to be one of the nurses that don't like paramedics. Ok, let's begin.

No. I am a Paramedic (and FF) who has a great respect for nurses and their profession. I have also spent the past 20 years dealing with legislative issues to increase the standards for Paramedics and EMS. Unfortunately there are too many like yourself who believe EMS is perfect and that the curriculum is way too hard now so there is absolutely no reason to change. Everytime we have debated you give the same lame excuses for EMS not to advance such as this one:

There is little clinical oversight for EMS students in the hospital environments and for a number of reasons many of which include poor this all too familiar attitude but also largely because no one in the hospital really knows what paramedics do nor why they're there.

No one understands the poor paramedic? What if there were Paramedic educators available onsite instead of turning 6 students loose in an ED to find their own way or expect others to babysit without as much as a plan from the school? Isn't it time EMS takes on some responsibility also? What if Paramedic instructors were required to have at least an Associates degree?

If you like EMS so much you need to stay current on what is going on around you in that world. Do you realize how difficult it is to even get states and schools to accept the idea of accreditation? Even the new NREMT credentials coming out in a couple years are a compromise and do little to add value to EMS.

I'd love for some six month paramedic mills to hit Arkansas. We need them.

Yes, just keep promoting those medic mills and dragging EMS further into the gutter.

Why doesn't your area just try recruiting from other parts of the country like Memphis did...until it started its own medic mill.

The program required 1200 hours total (minimum), but there's that gosh darn number again.

Most health care professions even at the Associates level require at least 1200 hours of just clinicals. Your Paramedic program was 1200 hours TOTAL.

Get your head out of your orifice and help the profession of EMS or get out of it totally and let those of us who deal with the reality of it across the board try to figure out how straighten out 40 years of a mess caused largely by those like you who believe all is perfect with an excuse for everything, medic mills are great with faster is better and fear any change coming to your perfect world. Education and advancement should not be so scary. EMS providers are lucky to get paid what they do now with the minimum standards it has now. The burnout and turnover comes from those who probably should never, never have gotten so easily into the profession and those who thought it would be just like the movies.

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No. I am a Paramedic (and FF) who has a great respect for nurses and their profession. I have also spent the past 20 years dealing with legislative issues to increase the standards for Paramedics and EMS. Unfortunately there are too many like yourself who believe EMS is perfect and that the curriculum is way too hard now so there is absolutely no reason to change. Everytime we have debated you give the same lame excuses for EMS not to advance such as this one:

No one understands the poor paramedic? What if there were Paramedic educators available onsite instead of turning 6 students loose in an ED to find their own way or expect others to babysit without as much as a plan from the school? Isn't it time EMS takes on some responsibility also? What if Paramedic instructors were required to have at least an Associates degree?

If you like EMS so much you need to stay current on what is going on around you in that world. Do you realize how difficult it is to even get states and schools to accept the idea of accreditation? Even the new NREMT credentials coming out in a couple years are a compromise and do little to add value to EMS.

Yes, just keep promoting those medic mills and dragging EMS further into the gutter.

Why doesn't your area just try recruiting from other parts of the country like Memphis did...until it started its own medic mill.

Most health care professions even at the Associates level require at least 1200 hours of just clinicals. Your Paramedic program was 1200 hours TOTAL.

Get your head out of your orifice and help the profession of EMS or get out of it totally and let those of us who deal with the reality of it across the board try to figure out how straighten out 40 years of a mess caused largely by those like you who believe all is perfect with an excuse for everything, medic mills are great with faster is better and fear any change coming to your perfect world. Education and advancement should not be so scary. EMS providers are lucky to get paid what they do now with the minimum standards it has now. The burnout and turnover comes from those who probably should never, never have gotten so easily into the profession and those who thought it would be just like the movies.

Where did I ever say or allude to it being perfect? You're the one that seems to look down your nose at the occupation. I never suggested anything about the curriculum being difficult. I didn't think that at all actually. EMS needs to change a lot. I think I've done a few posts in the past on this forum addressing that, and if not here then on another forum I frequent.

EMS is far from perfect. I was never anything but a part-timer, and I only did it because I enjoy working. Initially, my full-time job was teaching high school science (should show education isn't scary to me), and I left that to become a police officer.

To fix EMS there have to be enough members of the profession to want to do something about it. You're also going to have to reimburse them both as a provider and as an entity.

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What could you as an RN do in back of an ambulance anyway that an equipped paramedic can't?

I can not believe you would even ask such a question. The Paramedic scope of practice can be listed on one page and fit every med, piece of equipment and skill on that one page. You wanting more medic mills in your area is not going to improve that either.

Besides a long list of medications, skills and equipment the RN could also be the EMS gateway to community health rather than trying to give a paramedic in a fly car only a few hours of extra training on home care or chronic situations but not requiring them to even have college level anatomy and physiology. In no way is a Paramedic even remotely prepared to accept that challenge but an RN and would be the more logical choice just like in the U.K. as ECPs and other countries which use nurse led EMS systems especially since the U.S. Paramedic does not have any chance of becoming anything like Australia or Canada.

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I can not believe you would even ask such a question. The Paramedic scope of practice can be listed on one page and fit every med, piece of equipment and skill on that one page. You wanting more medic mills in your area is not going to improve that either.

Besides a long list of medications, skills and equipment the RN could also be the EMS gateway to community health rather than trying to give a paramedic in a fly car only a few hours of extra training on home care or chronic situations but not requiring them to even have college level anatomy and physiology. In no way is a Paramedic even remotely prepared to accept that challenge but an RN and would be the more logical choice just like in the U.K. as ECPs and other countries which use nurse led EMS systems especially since the U.S. Paramedic does not have any chance of becoming anything like Australia or Canada.

Yes, but you're putting the cart before the horse. If the ambulance is not equipped or regulated to allow for such equipment and medications then you'd be doing nothing but breaking the law.

I'm in full agreement that paramedics could do more. Should they? I don't think so - at least not right now. A lot needs to be addressed prior to that, and I've hinted at some of it.

The typical nurse can't fill the paramedic role either. There are too many sundry certifications and experiences to gain along the way prior to that.

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Yes, but you're putting the cart before the horse. If the ambulance is not equipped or regulated to allow for such equipment and medications then you'd be doing nothing but breaking the law.

That is done everyday when an RN has to get on a truck to accompany a Paramedic on an ED or ICU transfer because the Paramedic is not qualified to be manage some equipment and medications. Once the drips and ventilator are attached, an RN will usually have to accompany the patient to the next hospital if a transfer is in order such as to the cath lab. Many ambulance services must still transport to the closest facility even if the more appropriate hospital is a block away.

I'm in full agreement that paramedics could do more. Should they? I don't think so - at least not right now. A lot needs to be addressed prior to that, and I've hinted at some of it.

Paramedics are not in any position to expand but RNs are. It is senseless to try to make a 6 month trained Paramedic expand into a scope they are have neither the education prep or experience for. Most also have not desire to do anything but emergencies. So no, until Paramedics raise their education level to at least the minimum of an Associates degree, they will not be considered as health care professionals and CMS will not recognize them as such.

The typical nurse can't fill the paramedic role either. There are too many sundry certifications and experiences to gain along the way prior to that.

You really have an issue with nurses. What certifications do you think they can not get? ACLS? PHTLS? Disaster managment? Enough with the bashing of RNs. They have a good base education that can allow them to branch out into any specialty they choose. There are several specialties in nursing that requires much more education and training than all the certs in EMS combined. The typical Paramedic can not be a FF either unless they have extra training and meet the physical fitness standards. The typical Paramedic may also come out of school with only manikin intubation experience.

If nursing was to actually take more of an interest in prehospital medicine, who knows what direction EMS could take toward becoming an actual profession. However, right now RNs can enjoy a rather elite status knowing their presence on an ambulance or helicopter can make it a "Specialty Transport" which is recognized by CMS because of the expertise they bring to the patient.

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That is done everyday when an RN has to get on a truck to accompany a Paramedic on an ED or ICU transfer because the Paramedic is not qualified to be manage some equipment and medications. Once the drips and ventilator are attached, an RN will usually have to accompany the patient to the next hospital if a transfer is in order such as to the cath lab. Many ambulance services must still transport to the closest facility even if the more appropriate hospital is a block away.

Paramedics are not in any position to expand but RNs are. It is senseless to try to make a 6 month trained Paramedic expand into a scope they are have neither the education prep or experience for. Most also have not desire to do anything but emergencies. So no, until Paramedics raise their education level to at least the minimum of an Associates degree, they will not be considered as health care professionals and CMS will not recognize them as such.

You really have an issue with nurses. What certifications do you think they can not get? ACLS? PHTLS? Disaster managment? Enough with the bashing of RNs. They have a good base education that can allow them to branch out into any specialty they choose. There are several specialties in nursing that requires much more education and training than all the certs in EMS combined. The typical Paramedic can not be a FF either unless they have extra training and meet the physical fitness standards. The typical Paramedic may also come out of school with only manikin intubation experience.

If nursing was to actually take more of an interest in prehospital medicine, who knows what direction EMS could take toward becoming an actual profession. However, right now RNs can enjoy a rather elite status knowing their presence on an ambulance or helicopter can make it a "Specialty Transport" which is recognized by CMS because of the expertise they bring to the patient.

What do you want to do then? Eliminate EMTs? I'm fine with that as long as someone fills the role. You'll also have to agree that the nursing school doesn't immediately prepare someone for EMS. I didn't state that nurses could not get those certifications. We all know they do. I stated that they don't come from school prepared for that, i.e. they have to have that extra training. Paramedic school provides all of that as a part of the curriculum. I haven't bashed any RNs, but you've done a swell job of bashing EMS.

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